Toxicology Flashcards
What are antidotes to beta blocker and CCB toxicity?
Intralipid
Insulin and dextrose
Glucagon
Calcium (for CCBs)
Vasopressors
What is the typical illness script for a Copperhead bite?
Usually, it happens on a hand or foot. The initial symptoms are localized swelling and redness. The worst symptoms happen at 18-36 hours after the bite.
When should you treat a Copperhead bite with CroFab?
If someone has skin/MSK findings that progress past a joint line or they are having concerning progression of symptoms.
When should you use a tourniquet or suction on a snakebite?
Never. Tourniquets can cause concentrated tissue necrosis. Suction (with or without cutting) can cause localized inflammation that can deepen the path of venom into the wound.
True or false: baby snake bites are worse than adult bites.
False
When should you admit a person with a snake bite?
If you’ve given antivenom, recommend an observational admission.
How long after giving antivenom should you wait to reassess before redosing?
About 30 minutes It takes 30-60 minutes after finishing the bolus to reach peak effect.
When evaluating a snake bite, look for _____________.
oozing at fang marks – this is a reliable sign of envenomation
What are the two types of venomous snakes in the US?
Crotaline (copperheads, rattlesnakes) and Elapidae (coral snakes)
Crotaline toxin causes what lab abnormalities?
Thrombocytopenia and elevated INR
What immediate management should you do with snake bites?
- Immobilize the limb
- Remove jewelry on the affected limb
- Mark the leading edge of erythema
What physical exam things should you look for in a snake bite?
- Fang marks with oozing (sign of envenomation)
- Progression of erythema/edema
- Compartment syndrome
The mean age of people dying from opiates is ______.
37
Starting MAT in someone presenting from an overdose in the ED has been shown to decrease 1 year mortality by ___________.
59%
What are the side effects of methadone?
- Prolonged QT
- Tooth decay
True or false: methadone is a partial agonist.
False Buprenorphine is a partial opioid agonist. Methadone is a full agonist.
True or false: buprenorphine is a potent respiratory depressant.
False
Because it is a partial agonist, buprenorphine has a high ceiling of respiratory effects. It will typically only cause apnea if combined with something else.
You should only start buprenorphine when your patient is ___________.
in withdrawal
Because buprenorphine is a partial agonist, it can precipitate withdrawal if someone is still high.
Describe the screening process for lead toxicity in children.
Kids are screened with a capillary stick. If this is elevated (greater than 5 ug/dl) then you confirm with a venous lead. If the venous is 5-45 ug/dl you council on prevention strategies and rescreen later. If the venous is greater than 45 ug/dl you begin chelation therapy.
In general, when you see that someone is having unpleasant side effects from a drug but their levels are normal, try ______________.
decreasing the dose
Learning point: the drug level isn’t everything. You can have side effects at any dose.
____________ are the first-line treatment for PCP-associated agitation.
Benzodiazepines
Haldol as backup.
Saw palmetto is commonly used to treat as a supplement for what?
BPH
What are side effects of saw palmetto?
GI upset and increased bleeding risk
What are side effects of ginseng?
Increased bleeding risk